title: Endoscopic transethmoidal approach with or without medial rectus detachment for orbital apical cavernous hemangiomas.
abstract: OBJECTIVE
  To determine the indications for the addition of a transcaruncular approach along with detachment of the medial rectus muscle during the removal of small apical cavernous hemangiomas using an endoscopic transethmoidal approach.
  
  
  METHODS
  Retrospective, noncomparative case series.
  
  
  METHODS
  Multicenter study of 12 patients with apical orbital tumors removed using an endoscopic transethmoidal approach. The decision to detach the medial rectus muscle with the addition of a transcaruncular approach was made during surgery for tumors largely lateral to the medial rectus muscle. Tumors adjacent to the medial orbital wall were removed via an endoscopic transethmoidal approach alone.
  
  
  RESULTS
  Seven tumors were removed via an endoscopic transethmoidal approach combined with medial rectus muscle detachment, whereas 5 patients underwent removal without detachment of the medial rectus. All patients had visual impairment. Complete excision of the hemangiomas was achieved in all patients and tumor size ranged from 6 × 5 mm to 20 × 12 mm. The mean postoperative follow-up time was 11.8 ± 4.3 months. At final follow-up, the best-corrected visual acuity improved in 11 patients. Three patients had transient horizontal diplopia resulting from partial paralysis of the medial rectus muscle after detachment during surgery.
  
  
  CONCLUSIONS
  The endoscopic transethmoidal approach with or without medial rectus detachment is a promising approach for selected small cavernous hemangiomas located at the deep medial orbital apex. Detachment of the medial rectus muscle can be a useful technique for tumors located largely lateral to the medial rectus muscle. Further studies will be required to demonstrate the safety and efficacy of this technique.
authors.affiliation: Orbital and Oculoplastic Department, The Eye Hospital of Wenzhou Medical College, Wenzhou, Zhejiang, China. Electronic address: wuwencan118@163.com.
authors.forename: Wencan
authors.initials: W
authors.lastname: Wu
authors.affiliation: Discipline of Ophthalmology and Visual Sciences, University of Adelaide and South Australian Institute of Ophthalmology, Adelaide, Australia.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Selva
authors.affiliation: Ophthalmic Department, Quzhou People's Hospital, Quzhou, Zhejiang, China.
authors.forename: Fangzheng
authors.initials: F
authors.lastname: Jiang
authors.affiliation: Second Hospital of Zhengzhou City, Henan Province, China.
authors.forename: Wentao
authors.initials: W
authors.lastname: Jing
authors.affiliation: Orbital and Oculoplastic Department, The Eye Hospital of Wenzhou Medical College, Wenzhou, Zhejiang, China.
authors.forename: Yunhai
authors.initials: Y
authors.lastname: Tu
authors.affiliation: Orbital and Oculoplastic Department, The Eye Hospital of Wenzhou Medical College, Wenzhou, Zhejiang, China.
authors.forename: Ben
authors.initials: B
authors.lastname: Chen
authors.affiliation: Orbital and Oculoplastic Department, The Eye Hospital of Wenzhou Medical College, Wenzhou, Zhejiang, China.
authors.forename: Jieliang
authors.initials: J
authors.lastname: Shi
authors.affiliation: Discipline of Ophthalmology and Visual Sciences, University of Adelaide and South Australian Institute of Ophthalmology, Adelaide, Australia.
authors.forename: Michelle T
authors.initials: MT
authors.lastname: Sun
authors.affiliation: Orbital and Oculoplastic Department, The Eye Hospital of Wenzhou Medical College, Wenzhou, Zhejiang, China.
authors.forename: Jia
authors.initials: J
authors.lastname: Qu
mesh_terms: D000328:Adult; D004724:Endoscopy / Q000379:methods*; D005005:Ethmoid Sinus / Q000601:surgery; D005260:Female; D006392:Hemangioma, Cavernous / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D009918:Orbital Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult